Her 12-year-old son, who struggles with severe anxiety and panic attacks, was having a crisis. He was suicidal and couldn't be left alone.

But on a Friday night in January, Rosenthal couldn't find a bed in a treatment facility for her son anywhere, even after a social worker in the emergency room at Children's Hospital of Wisconsin determined he needed inpatient treatment as soon as possible.

“He wasn’t safe at home and nobody would keep him,” Rosenthal said in an interview with USA TODAY NETWORK-Wisconsin.

So, Rosenthal and her husband stayed awake and watched him. They didn't know what else to do.

Rosenthal, who lives in Menomonee Falls, fruitlessly called nearby hospitals throughout that weekend. She finally found her son a place at a nearby treatment facility the following Monday.

He didn't stay long, though. Two weeks later, her son was back at home, despite her belief that he "wasn't in any condition to go home," Rosenthal said.

This wasn't the first time Rosenthal had experienced what many parents and youth mental health professionals already know: There aren't enough therapists, psychologists or psychiatrists in the state to meet the needs of people with mental health problems, or enough beds for those who need treatment.

“There’s no place for them to go,” Rosenthal said. “There’s not enough people to help.”

This isn't a new problem. It's a product of both economics and geography, and there are no easy fixes.

For years, many people training to be doctors tended to avoid work in the mental health field, which typically isn't as highly paid or as profitable for hospitals as other medical specialties.

Wisconsin has a total of 148 practicing child psychiatrists, or 12 for every 100,000 residents younger than 18, according to the American Academy of Child and Adolescent Psychiatry. That's about a quarter of the academy's recommended amount.

And of those 148 psychiatrists, 111 are located in just four counties: Brown, Dane, Milwaukee and Waukesha.

Meanwhile, the need for mental health services has increased, making the shortage more obvious. As a result, providers have found themselves struggling to keep up, increasingly turning their focus to prevention and early intervention in an effort to keep kids struggling with their mental health out of emergency rooms and inpatient treatment.

Months earlier, when Rosenthal called Children's Hospital of Wisconsin hoping to get an appointment for her son, the wait to see someone seemed unthinkable — seven or eight months, at least, she said.

But that's not at all an unusual experience for patients and their families, said Amy Herbst, vice president of mental and behavioral health for Children’s Hospital of Wisconsin, which has outpatient clinics across the state.

“Every day, we have families calling us all around the state attempting to get an appointment with a therapist,” she said.

The response to those calls is typically the same: The wait could be weeks or even months.

“We all just feel terrible about it because we want to do better,” Herbst said. “And we will do better, but we’re not in that position yet.”

'A devastating situation'

More children in Wisconsin are struggling with mental health challenges, even as a shortage of providers makes it more difficult to get help.

More than 16 percent of students have considered suicide, while nearly 8 percent attempted to take their own lives.

In 2017, Wisconsin's suicide rate for children ages 10 to 17 was 6.6 per 100,000, up from 4.3 per 100,000 in 2012, according to the Centers for Disease Control and Prevention. The national suicide rate for children those same ages was 5.3 per 100,000 in 2017, up from 3.5 per 100,000 in 2012.

The rate of youth mental health hospitalizations in Wisconsin — 7 per 1,000 in 2015 — remains high compared to the national rate of about 1.6 per 1,000 in 2014.

The consequences of untreated mental illness can be dire, which makes health care providers especially fearful about what the shortage means for their patients.

“We don’t want access to be one of the reasons why that tragedy occurred,” Herbst said, referring to youth suicide. “But that’s really what happens.”

Even when the situation isn’t yet that serious, many families still struggle when they’re not able to find help for a child right away, said Joanne Juhnke, policy director at Wisconsin Family Ties, a Madison-based organization that helps families with children that have mental health challenges.

“That’s really a devastating situation for families,” she said.

Smriti Khare, a pediatrician and president of Children’s Hospital of Wisconsin Primary Care, said families often try to handle the situation themselves, only seeking out help when it's a crisis.

“The hardest thing is when you’re in a room with a family and you know they need help right away,” she said.

'A long way to go'

Jon Lehrmann, chairman of psychiatry and behavioral medicine at the Medical College of Wisconsin, said the situation is actually even worse than that. Many psychiatrists trained to treat children spend at least a portion of their time helping adults, further limiting their availability.

“If we had this kind of shortage of surgeons, I think we would have a national emergency,” Lehrmann said.

“If we had this kind of shortage of surgeons, I think we would have a national emergency.”

Jon Lehrmann, chair of psychiatry and behavioral medicine at the Medical College of Wisconsin

There haven't been enough child psychiatrists in Wisconsin — or nationally, for that matter — for decades, he said.

Many health systems didn't always seek out psychiatrists, he said, because they weren't as profitable as other doctors. That's finally starting to change.

The Medical College has been working to reduce the shortage of psychiatrists in rural areas since 2017, when it launched psychiatry residency programs in Green Bay and Wausau with the aim of training them and hopefully keeping them employed in places closer to areas with the greatest need.

Eight doctors are currently enrolled in the four-year program in Green Bay, which is expected to grow to 16 when it is fully enrolled next year. The Wausau program will enroll 12 resident psychiatrists in 2020.

The Medical College says establishing the programs in northeastern and central Wisconsin can help alleviate the shortage now and in the long term because roughly two thirds of physicians settle in the community in which they are trained.

Mayo Clinic has set up a similar program in Eau Claire.

“We’re making progress, but we’ve got a long way to go,” Lehrmann said.

Solutions won't be quick

In March, Gov. Tony Evers toured Catalpa Health, a facility near Appleton that specializes in mental health care for young people. There, Evers, a Democrat, spoke to reporters and compared the shortage of mental health care providers to workforce challenges faced by other industries in the state.

Evers' proposed two-year budget for the state would expand Medicaid to enroll an additional 82,000 people and add $22 million each year to help schools pay for social workers, psychologists, counselors and nurses in an effort to help students struggling with mental health.

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Client Access Specialist Isabella Hielsberg at work in the call center at Catalpa Health in Grand Chute.(Photo: William Glasheen, USA TODAY NETWORK-Wisconsin)

But the governor's budget requires approval from the Republican-controlled state Legislature, which has already signaled it will strip many of Evers' initiatives from the budget.

Evers was joined at Catalpa by Sen. Tammy Baldwin, a Democrat, who urged Wisconsin lawmakers to support Evers' effort to expand Medicaid in the state.

“Our state has an overall shortage that’s very, very significant,” said Baldwin, who described the issue as an "urgent priority" for those deciding budgets at the state and federal levels.

There are signs that the situation is starting to improve in Wisconsin. More medical students are deciding to pursue careers in psychiatry as more health systems now find value in those positions, Lehrmann said.

Meanwhile, an effort by many health care providers to make behavioral health more widely available as part of primary care has helped too, Lehrmann said. That leads to more issues being caught early, hopefully avoiding more intensive and costly treatment down the line.

“We all lose so much sleep over these kids. You worry about them.”

Smitri Khare, a pediatrician and president of Children's Medical Group

For example, Children's Hospital of Wisconsin has a behavioral health specialist in 19 of its 26 clinics across the state, and they're shared among the rest of the sites, said Khare, the pediatrician.

Patients are less likely to worry about stigma when they're going to a familiar doctor's office, Khare said. The arrangement also gives pediatricians more chances to learn about mental health from people in those specialties.

Still, it's hard not to feel inadequate as a health care provider when you're unable to get a patient the help they need right away, Khare said.

“We all lose so much sleep over these kids,” she said. “You worry about them.”

Children's Hospital also partnered with Ascension Wisconsin and ThedaCare about five years ago to form Catalpa Health, a partnership that aims to improve access to youth mental health services in northeastern Wisconsin.

Catalpa has clinics in Grand Chute, Oshkosh and Waupaca, and staff at about 50 schools in the region, said Mary Downs, Catalpa's president.

“Care was really spread out across the systems,” Downs said. “We brought it all together under one roof.”

Catalpa employs six psychiatric providers — a combination of doctors and nurse practitioners who can prescribe medication — five psychologists and about 50 licensed therapists, Downs said.

But that doesn't mean Catalpa is immune from the workforce issues challenging the rest of the industry. The organization tries to give priority to urgent cases, typically leaving a few appointment slots open for patients who need more immediate attention, Downs said.

Downs pointed to a key challenge to increasing the ranks of therapists: Wisconsin requires licensed therapists to get 3,000 hours in the field after they graduate before they're able to be reimbursed by insurance.

Many nonprofit organizations can't afford to pay therapists when they're not being reimbursed, Downs said.

“A lot of people end up leaving the field because they can’t get their 3,000 hours,” she said.

Herbst, at Children's Hospital, said her organization also has concerns about that requirement for therapists.

“Most people cannot afford to volunteer their time for a year and a half to get those 3,000 hours,” Herbst said.

To help people meet the requirement, Children's Hospital plans to start a program this spring that will involve hiring people to complete a specific training program to become a full-time therapist. Children's Hospital hopes to have at least 25 people complete the program in the next five years, Herbst said.

But that alone won't solve the problem. More young people need to be encouraged to consider careers in mental health, Herbst said. And health care providers need to continue to focus on prevention and early intervention.

“The solution can’t be to just hire more people,” she said. “That’s never worked and it’s not going to work going forward.”

Hear from Wisconsin children

USA TODAY NETWORK-Wisconsin will host two more free viewings of "You're Not Alone," a documentary produced in collaboration with Milwaukee PBS. Children are welcome, but please note the film deals sensitively with difficult subjects like suicide and sexual assault.

Appleton: 6 p.m. May 29 at the Fox Cities Performing Arts Center, 400 W. College Ave. Register at bit.ly/notaloneapc or watch live at facebook.com/postcrescent.

Wausau: 6 p.m. June 4 at the Marathon County Public Library, Wausau Headquarters, 300 1st St. Register at bit.ly/notalonew or watch live at facebook.com/wausaudailyherald.

Want to host your own screening?

If you'd like to host a screening and discussion for your school or community, you can find a free stream and toolkit at jsonline.com/yourenotalone. You may also request a free DVD copy of the film.

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